Background: Most studies on chemsex focus on the health risks associated with the practice, whereas less attention has been paid to the perception of sexual gratification in men who have sex with men (MSM) who use these substances. Aim: The purpose of this study was to explore the effects of chemsex substances on sexual response, motivations to engage in chemsex and the relationship with sober sex. Methods: Thirty-one Italian cisgender MSM involved in sexualized drug use were interviewed and transcripts were thematically analyzed. Outcomes: An ad hoc grid exploring sociodemographic data, chemsex sexual experience, motives, and relationships with sober sex was used during telephone-based interviews. Results: Participants showed significant individual differences in how chems may affect their sexual experience. The most reported effects were an increase in sexual desire and subjective arousal, access to higher disinhibition, possible erection and ejaculation difficulties, significant extension of the sexual experience duration, and an intensified perception of intimacy and pleasure. All the positive outcomes of substances on sex creates a great curiosity around chemsex, which is among the primary motives to engage in chemsex for the first time. Over time, other motives may emerge, also connected to substance abuse and craving. Some men reported to be motivated by their partners and friends and to use chemsex to cope with depressive mood/anxiety symptoms, stress and sexual problems. Many differences were reported between chemsex and sober sex. Chemsex seems to embody the idea of transgressive and exciting sex, while sober sex is outlined as a more intimate encounter, that can be significantly affected by performance anxiety. Clinical Translation: These results offer some new perspectives that may add interesting information to the literature and be fundamental for future prevention and harm-reduction projects. Strengths & Limitations: Although this study is based on a small group of Italian MSM and the interviews were not audio-recorded, transcripts were consistent with scientific literature that considers it important to pay attention to the positive links between sex and substance use. Conclusion: The promotion of safer sexual behavior should contemplate an in-depth discussion and recognition of both pleasurable and distressing aspects of chemsex sexual experience, its motivations over time and perceived differences with sober sex. Copyright (C) 2021, International Society of Sexual Medicine. Published by Elsevier Inc. All rights reserved.

INTRODUCTION:Chemsex in a European context is the use of any of the following drugs to facilitate sex: crystal methamphetamine, mephedrone and gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL) and, to a lesser extent, cocaine and ketamine. This study describes the prevalence of self-reported recreational drug use and chemsex in HIV-positive men who have sex with men (MSM) accessing HIV services in four countries. It also examines the problematic impacts and harms of chemsex and access to chemsex-related services.METHODS:This is a cross-sectional multi-centre questionnaire study of HIV-positive MSM accessing nine HIV services in the UK, Spain, Greece and Italy.RESULTS:In all, 1589 HIV-positive MSM attending HIV services in four countries completed the questionnaire. The median age of participants was 38 years (interquartile range: 32-46 years) and 1525 (96.0%) were taking antiretroviral therapy (ART). In the previous 12 months, 709 (44.6%) had used recreational drugs, 382 (24.0%) reported chemsex and 104 (6.5%) reported injection of chemsex-associated drugs ('slamsex'). Of the 382 engaging in chemsex, 155 (40.6%) reported unwanted side effects as a result of chemsex and 81 (21.2%) as a result of withdrawal from chemsex. The reported negative impacts from chemsex were on work (25.1%, 96), friends/family (24.3%, 93) and relationships (28.3%, 108). Fifty-seven (14.9%) accessed chemsex-related services in the past year, 38 of whom (67%) felt the service met their needs.DISCUSSION:A quarter of participants self-reported chemsex in the past 12 months. There were high rates of harms from chemsex across all countries, including negative impacts on work, friends/family and relationships. Although a minority of those engaging in chemsex accessed support, most found this useful.

Background: Chemsex is a novel phenomenon referring to the consumption of illicit drugs to facilitate, enhance, and prolong the sexual experience in men who have sex with men (MSM). Aim: The present study aims to investigate contexts, patterns of substance use, first chemsex experience, and harm reduction in a group of MSM practicing chemsex in Italy. Methods: Thirty MSM involved in chemsex activities were interviewed between February and July 2019. Outcomes: The interviews were conducted using an ad hoc grid exploring general characteristics of Italian chemsex, patterns of substance use, first chemsex experience, and harm reduction opinions. Results: Chemsex in Italy showed important peculiarities and patterns because of sociocultural background. Chemsex was mainly reported in private venues within couple and group sexual activities. Most participants attended chemsex sessions about 1-2 times per month often concurring with men-only club events. Freebase cocaine emerged among the most relevant substances consumed together with gamma-hydroxybutyrate/gamma-butyrolactone, crystal methamphetamine, and mephedrone. A rare use of injected substances compared with other European Union countries was shown. Given the high prevalence of erectile problems, a large use of phosphodiesterase type 5 inhibitors was reported, and noncoital sexual activities were usually preferred (eg, oral sex, fist fucking). The first chemsex experiences were usually accessed by geolocation-based dating apps and sexual partners and were generally described as positive experiences, with some negative consequences at the end of the session (dysphoric mental states, guilt, craving). Taking part in international gay events seems to favor the first experience of chemsex for some participants. Moreover, some MSM practiced chemsex only abroad or in other cities in Italy so as not to be recognized as chem users in their daily environment. Clinical Translation: Implications for ad hoc harm reduction programs are discussed. Strengths & Limitations: Despite the methodological limitations due to participants' number and the absence of interviews audio recording, results highlighted some relevant characteristics of chemsex in Italy, such as freebase cocaine use, attitudes regarding slamming, geographical movements, and secrecy. Conclusion: The results revealed a need for greater scientific and public attention on chemsex to act with the most specific and effective prevention and harm reduction tools. Copyright (C) 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Chemsex is referred to illicit drugs use (GHB/GBL, methamphetamine, and mephedrone) to enhance the sexual activity in Men who have Sex with Men (MSM). Most studies focused on the health risks associated to chemsex, while less attention was paid on the effects on sexual response and motivations to engage in this behavior. The current study aims to investigate how drugs used in chemsex might affect the sexual activity and which are the motivations encouraging men to use them. 20 MSM involved in chemsex activities (mean age = 38.6±12.4) were assessed with an ad hoc semi-structured interview between February and July 2019 exploring sexuality in chemsex. Interviews transcripts were thematically analyzed. Inclusion criteria were being cisgender MSM and having at least a chemsex experience in the last year. Participants showed significant individual differences in the effects of chemsex drugs on sexuality. The most common effects were an increase in sexual desire and subjective arousal, usually associated with a higher disinhibition and the presence of erectile difficulties. Some men reported a significant extension of the sexual experience (till 24-48 hours), with consequent delais and difficulties in reaching orgasms. Many participants highlighted an intensified perception of intimacy during chemsex. Regarding feelings and motivations, the increase in arousal and pleasure are the most frequent factors reported, followed by the possibility to lose controls and being considered as part of an intimate group/community. Some men reported to be motivated by their partners and friends and to use chemsex drugs as palliative for negative mental states and sexual/identity problems.

Background. Recent evidence has suggested that chemsex (the use of mephedrone, crystal methamphetamine and gamma -hydroxybutyrate/ gamma -butryolactone (GHB/GBL) to enable, enhance and prolong sexual interactions) has increased among men having sex with men (MSM) attending sexual health clinics in large UK cities. To date there has been no data from the UK or Europe that describes changes in chemsex over time within a cohort of MSM. Methods: The prospective cohort study, Attitudes to and Understanding Risk of Acquisition of HIV over Time (AURAH2), collected online questionnaire data from HIV negative or undiagnosed MSM (at enrolment) from 2015 to 2018, recruited from sexual health clinics. We aim to investigate changes in chemsex, three individual drugs associated with chemsex, frequency of chemsex sessions and measures of sexual behaviour, among the cohort of MSM over the study's 3 year follow-up period. Results: In total 622 MSM completed at least one online questionnaire for the AURAH2 study, of which 400 (64.3%) were still engaged with the study within the last six months of follow-up. Prevalence of chemsex significantly declined during the follow-up from 31.8% (198/622) at the first online questionnaire, to 11.1% (8/72; p < 0.001) at the 9th. This decline was reflected in the proportion of MSM reporting use of two of the three individual chemsex drugs: mephedrone use had significantly declined from 25.2% at the first online questionnaire to 9.7% (p < 0.001) at the 9th, GHB/GBL use had also declined from 19.9% to 8.3% (p = 0.001). While crystal methamphetamine use declined, but not significantly (11.1%-6.9% [P = 0.289]). Most measures of sexual behaviour (any anal sex, group sex, recent HIV test and bacterial STI) also tended to decline over the follow-up period, with the exception of CLAI with more than one and more than two partners. Conclusions: Chemsex and use of two individual chemsex drugs (mephedrone and GHB/GBL) significantly declined over time among individuals in the study, alongside most measures of sexual behaviour with the exception of those related to CLAI. Focusing health promotion and HIV prevention, such as awareness of post-exposure prophylaxis (PEP) and access to pre-exposure prophylaxis (PrEP), on MSM that report chemsex, and in particular problematic chemsex, would be highly beneficial, potentially only necessary for a relatively short period of time for individuals, and could have long term benefits for HIV and STI prevention.

A message from the guest editor of this special "Chemsex" edition of Drugs and Alcohol Today Despite a growing number of deaths by overdose or rising incidence of HIV, the wider gay community largely ignored the contribution that illicit drugs, largely synthetic stimulants consumed orally, intranasally or anally but rarely injected, had to morbidity and mortality in their community.Harm reduction was originally focussed on the prevention of HIV and other blood borne diseases acquired through injecting drug use.The focus of interventions was street based and focussed on people who injected opioids.Despite there being LBGT people represented in harm reduction, there was a prevailing culture of heteronormativity that was a barrier to accessing services for some.

Purpose The purpose of this paper is to clarify the origins, use and meaning of the term “chemsex”. Design/methodology/approach The approach used here is one born of personal experiences and reflection. Findings The term chemsex has a definition and a purpose that promotes culturally competent care for a marginalized group of vulnerable people. Research limitations/implications This is a qualitative, personal, point-of-view piece which may be of value in broadening understandings and responses amongst public health and academic activities. Practical implications The findings can be used to develop a sense of community and support amongst men who have sex with men in a chemsex setting, and to provide some background and context for professionals working in this field. Originality/value This paper is amongst the first, if not the first, of its nature to be published in an academic journal.

Objectives The objective of this study was to compare the prevalence of polydrug use, use of drugs associated with chemsex, specific drug use, and HIV-related behaviours, between two time periods, using two groups of HIV-negative men who have sex with men (MSM) attending the same sexual health clinics in London and Brighton, in two consecutive periods of time from 2013 to 2016. Methods Data from MSM in the cross-sectional Attitudes to and Understanding Risk of Acquisition of HIV (AURAH) study (June 2013 to September 2014) were compared with baseline data from different MSM in the prospective cohort study Attitudes to and Understanding Risk of Acquisition of HIV over Time (AURAH2) (November 2014 to April 2016). Prevalence of polydrug use, drug use associated with chemsex and specific drug use, and 10 measures of HIV-related behaviours including condomless sex, post-exposure prophylaxis (PEP) use, pre-exposure prophylaxis (PrEP) use, and HIV testing, were compared. Prevalence ratios (PRs) for the association of the study (time period) with drug use and HIV-related behaviour measures were estimated using modified Poisson regression analysis, unadjusted and adjusted for sociodemographic factors. Results In total, 991 MSM were included from AURAH and 1031 MSM from AURAH2. After adjustment for sociodemographic factors, use of drugs associated with chemsex had increased (adjusted PR (aPR) 1.30, 95% CI 1.11 to 1.53) and there were prominent increases in specific drug use; in particular, mephedrone (aPR 1.32, 95% CI 1.10 to 1.57), γ-hydroxybutyric/γ-butryolactone (aPR 1.47, 95% CI 1.15 to 1.87) and methamphetamine (aPR 1.42, 95% CI 1.01 to 2.01). Use of ketamine had decreased (aPR 0.54, 95% CI 0.38 to 0.78). Certain measures of HIV-related behaviours had also increased, most notably PEP use (aPR 1.50, 95% CI 1.21 to 1.88) and number of self-reported bacterial STI diagnoses (aPR 1.24, 95% CI 1.08 to 1.43). Conclusions There have been significant increases in drug use associated with chemsex and some measures of HIV-related behaviours among HIV-negative MSM in the last few years. Changing patterns of drug use and associated behaviours should be monitored to enable sexual health services to plan for the increasingly complex needs of some clients.

People who inject drugs (PWID) and HIV-infected men who have sex with men (MSM) are key risk groups for HCV transmission. Mathematical modeling studies can help elucidate what level and combination of prevention intervention scale-up is required to control or eliminate epidemics among these key populations. We discuss the evidence surrounding HCV prevention interventions and provide an overview of the mathematical modeling literature projecting the impact of scaled-up HCV prevention among PWID and HIV-infected MSM. Harm reduction interventions, such as opiate substitution therapy and needle and syringe programs, are effective in reducing HCV incidence among PWID. Modeling and limited empirical data indicate that HCV treatment could additionally be used for prevention. No studies have evaluated the effectiveness of behavior change interventions to reduce HCV incidence among MSM, but existing interventions to reduce HIV risk could be effective. Mathematical modeling and empirical data indicate that scale-up of harm reduction could reduce HCV transmission, but in isolation is unlikely to eliminate HCV among PWID. By contrast, elimination is possibly achievable through combination scale-up of harm reduction and HCV treatment. Similarly, among HIV-infected MSM, eliminating the emerging epidemics will likely require HCV treatment scale-up in combination with additional interventions to reduce HCV-related risk behaviors. In summary, elimination of HCV will likely require combination prevention efforts among both PWID and HIV-infected MSM populations. Further empirical research is required to validate HCV treatment as prevention among these populations, and to identify effective behavioral interventions to reduce HCV incidence among MSM.

Background: Recreational drug use and associated harms continue to be of significant concern in men who have sex with men (MSM) particularly in the context of HIV and STI transmission.Methods: Data from 1484 HIV-negative or undiagnosed MSM included in the AURAH study, a cross-sectional, self-completed questionnaire study of 2630 individuals from 20 sexual health clinics in the United Kingdom in 2013-2014, was analysed. Two measures of recreational drug use in the previous three months were defined; (i) polydrug use (use of 3 or more recreational drugs) and (ii) chemsex drug use (use of mephedrone, crystal methamphetamine or GHB/GBL). Associations of socio-demographic, health and lifestyle factors with drug use, and associations of drug use with sexual behaviour, were investigated.Results: Of the 1484 MSM, 350 (23.6%) reported polydrug use and 324 (21.8%) reported chemsex drug use in the past three months. Overall 852 (57.5%) men reported condomless sex in the past three months; 430 (29.0%) had CLS with >= 2 partners, 474 (31.9%) had CLS with unknown/HIV+ partner(s); 187 (12.6%) had receptive CLS with an unknown status partner. For polydrug use, prevalence ratios (95% confidence interval) for association with CLS measures, adjusted for socio-demographic factors were: 1.38 (1.26,1.51) for CLS; 2.11 (1.80, 2.47) for CLS with >= 2 partners; 1.89 (1.63, 2.19) for CLS with unknown/HIV+ partner(s); 1.36 (1.00, 1.83) for receptive CLS with an unknown status partner. Corresponding adjusted prevalence ratios for chemsex drug use were: 1.38 (1.26, 1.52); 2.07 (1.76, 2.43); 1.88 (1.62, 2.19); 1.49 (1.10, 2.02). Polydrug and chemsex drug use were also strongly associated with previous STI, PEP use, group sex and high number of new sexual partners. Associations remained with little attenuation after further adjustment for depressive symptoms and alcohol intake.Conclusion: There was a high prevalence of polydrug use and chemsex drug use among HIV negative MSM attending UK sexual health clinics. Drug use was strongly associated with sexual behaviours linked to risk of acquisition of STIs and HIV. (C) 2017 Elsevier B.V. All rights reserved.

The public health response to chemsex, when understood objectively, is actually a simple model of multidisciplinary interventions. Just as opiate addiction requires behavioural therapies, medicine, community engagement, and an understanding of the motivations for use, chemsex requires – well, exactly the same. Many excellent models of chemsex support already exist internationally.1–3Unfortunately, however, you can't remove the sex from chemsex; and where there is sex, there are moral and religious judgments and stigmas. Make that gay sex, include HIV, and chemsex becomes something that can require some untangling before an effective public health response can be mounted.The untangling must, therefore, begin with a definition. Chemsex is a word invented on geo-sexual networking apps by gay men (and adopted by the gay men's health sector) that defines a syndemic of specific behaviours associated with specific recreational drugs, and is particular to a specific, high-risk population.Though the media spotlight may have distorted the term to define the use of any drugs in sexual contexts by any population,4 chemsex actually refers to the use of any combination of drugs that includes crystal methamphetamine, mephedrone and/or gammahydroxybutyrate (GHB)/gammabutyrolactone (GBL), used before or during sex by men who have sex with men (MSM). These …

A study is reported on cataract surgery, with intraocular lens implant, with measurement of the preoperative astigmatism and of the postoperative astigmatism over 28 weeks. Nine interrupted 10/0 nylon sutures are used to close a limbal section. Preoperative astigmatism is compensated for in the method of suturing by the placement of additional sutures. Postoperatively sutures are cut in line with the plus cylinder axis in eyes showing excessive astigmatism with the rule. Final postoperative astigmatism is controlled within 2.25 D cyl. 68% of cases lie within 1.0 D cyl with the rule to 1.0 D cyl against the rule. The average case in which sutures are not cut is one having 1.51 D cyl with the rule at one week postoperatively, declining to zero at approximately 12 weeks, and having a final value of 0.17 D cyl against the rule. No significant change in cylinder is seen after 10 weeks. The final postoperative astigmatism is only weakly correlated with the preoperative astigmatism, showing that the surgical method is effective. The spherical equivalent error is shown to shift in the direction of myopia in the postoperative period.

Background/introduction With much speculation and anecdotal reports regarding the causal links between sexualised recreational drug use by MSM (commonly referred to as ‘ChemSex’) and HIV/HCV rates, there has been much demand from commissioners and researchers and practitioners to identify the extent of the problem. In 2014, one London GUM/HIV clinic launched the NHS’ first targeted ChemSex clinic. This presentation includes robust data collected from 874 unique presentations in the first year of this landmark clinic. Aim(s)/objectives The objective was to satisfy the health sector’s concerns about the extent of this much hyped syndemic, with qualitative and quantitative data as well as assess interventions and cohort engagement methods. Methods Targeted clinics and outreach services were established with skilled addiction staff and resourcing peer volunteers, collecting culturally and contextually appropriate behavioural trends and data. Results Data includes: Effectiveness of certain contextually-appropriate questions re ChemSex during GUM consultation. ARV non-adherence amongst high-risk ChemSex party-goers who favour condomless sex. Condom use (or otherwise) and number of partners broken down to include HIV+ve MSM not on treatment. HIV/HCV broken down to include sexual acquisition versus injecting drug use acquisition. HCV data broken down to include number of re-infections amongst HIV-ve non-injecting drug users. Discussion/conclusion This presentation includes the data, offers examples of how this model might be adapted in other services, and incorporates some training for attendees in how to overcome fears or ignorance regarding drug use risk assessments and consultations; it also includes film footage of role play exercises for skill-building purposes.

Use of 'party drugs', a particular set of recreational drugs used in the context of 'ChemSex', is frequent among MSM living with HIV. A recently published observational study showed that more than half of HIV-infected MSM interviewed reported use of illicit substances in the previous 3 months, with frequent concomitant use of three or more drugs. These substances are a combination of 'club drugs' (methylenedioxymethamphetamine, gamma-hydroxybutyrate, ketamine, benzodiazepine) and drugs that are more specifically used in a sexualized context (methamphetamine, mephedrone, poppers and erectile dysfunction agents). Although formal data on pharmacokinetic or pharmacodynamic interactions between recreational drugs and antiretroviral agents are lacking, information regarding potentially toxic interactions can be theorized or sometimes conclusions may be drawn from case studies and cohort observational studies. However, the risk of coadministering party drugs and antiretrovirals should not be overestimated. The major risk for a drug–drug interaction is when using ritonavir-boosting or cobicistat-boosting agents, and maybe some nonnucleoside reverse transcriptase inhibitors. Knowledge of the metabolic pathways of 'party drugs' may help in advising patients on which illicit substances have a high potential for drug–drug interactions, as this is not the case for all.

Future VirologyVol. 10, No. 4 InterviewFree AccessCultural competency for clinicians: ChemSex and coinfectionDavid StuartDavid Stuart*56 Dean Street, GUM/HIV, Chelsea & Westminster hospital NHS Foundation Trust, London, UK; E-mail Address: David.stuart@chelwest.nhs.ukPublished Online:27 Apr 2015https://doi.org/10.2217/fvl.15.24AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInRedditEmail Q Could you tell our readers a little about how your career began?I had been volunteering with an opiate/crack cocaine service in London's Soho when ChemSex [1] trends among gay men (that is the sexualized drug used by gay men) began manifesting as a serious public health concern within that population. The lesbian, gay, bisexual and transgender (LGBT) project within that service was struggling to cope with increasing presentations of gay men reporting the use of crystal methamphetamine, mephedrone and GBL over 2–3-day 'sex benders' that were associated with multiple sexual partners, extreme or unsafe sexual practices, injecting drug use and sexually transmitted infections. In 2012, 90% of the HIV/HCV positive MSM clients visiting the service attributed their status' directly to the use of drugs and alcohol [2]. This early work enabled me to develop an understanding and familiarity with the context, motivations and epidemiology of these behaviors, and to begin developing care pathways and interventions to address this complicated syndemic. I was soon managing a targeted project for these trends at an LGBT charity, and in 2014, was employed by 56 Dean Street to address the trends within the genito-urinary medicine/HIV sector.Q What initially sparked your interest in working with those with HIV?Although I had been HIV positive myself since 1990, my interests had focused more on the cultural and holistic wellbeing of MSM drug users, and the underlying reasons driving the ChemSex syndemic. HIV was not the motivation for my work, just one of the many undesired consequences of ChemSex. I was struggling to get the issue on a public health agenda; the substance misuse sector felt this was a sexual health sector responsibility, and the sexual health sector felt it ought to be up to the substance misuse sector to respond. And while the buck was being passed backward and forth, more and more MSM were presenting for postexposure prophylaxis, or to their HIV appointments following ChemSex experiences. There are many gay men whose lives have been devastated, in many ways, by ChemSex, and by a myriad of consequences; but it is the HIV risks that secure its' place on the public health agenda. I felt very urgently that I ought to be doing my work right there, in the HIV prevention field.Q Have any colleagues, past or present, particularly influenced you & your work?In the 1980s, Lord Norman Fowler battled to make needle and syringe provision available to injecting drug users from the public purse; it had been illegal to possess or dispense them prior to his battle, and many felt that giving out needles to 'junkies' was simply enabling self-indulgent drug users. Yet it became a primary tool to prevent the transmission of HIV among that population. ChemSex stimulates some similar responses; "Why don't those hedonistic, promiscuous gay men just stop doing drugs?". Targeted ChemSex support ought to be provided as standard HIV prevention, without challenge or stigma, and funded by the public purse. It is simple HIV prevention. I identify with Lord Fowler's persistence to battle stigma, and find it inspiring.Q What is the most challenging part of your job?The most challenging is addressing the route causes of ChemSex. There have been challenges in putting it on the public health agenda, and developing tailored interventions; but that is just treating the problem. True prevention means addressing the stigmas that exist within and without gay communities about sex and disease, and understanding the full impact smartphone apps and technology are having on our sex and romantic lives. True prevention is incorporating LGBT-inclusive (age-appropriate) sex and relationship education in schools, so we may navigate the complicated world of modern sex, technology diversity and drug availability; and learn the role intimacy, respect and boundaries play in our sex/romantic lives.Q Additionally, what do you find to be the most rewarding?The most rewarding is undoubtedly the community engagement work. In 2014, Leigh Chislett and I began the Dean Street Wellbeing programme [3], a series of fun, creative and educational events that raise awareness, stimulate dialogue and address sexual and community wellbeing. The aim is to put sexual wellbeing at the heart of sexual health; if people experience good community cohesion, can robustly engage in dialogues on challenging topics, and experience good sexual/holistic wellbeing, good sexual health will follow. Less disease, less self-harm, less drug use and less poor mental health.Q You have recently been involved with releasing a guide for clinicians & health professionals surrounding HIV/HCV coinfection & substance abuse in men. How have these issues been addressed in the last 10 years?In substance misuse services, it has been well addressed; the risks of HIV/HCV in the context of street homelessness/intravenous drug use have been well understood by staff in this field, and great work has been done to communicate safer practice to people at risk. The sexual transmission of HCV among MSM, however, has been marred by conflicting research about the transmission risks, and further marred by some clinicians not being fully aware of the specific contexts/details of certain gay sex practices, or in some cases, discomfort in discussing more extreme sexual practices with MSM patients.Q Why is this guide needed in current healthcare?ChemSex behaviors can be challenging, or difficult to comprehend for many of us; it can be extreme, appear self-harmful, illogical and yet our patients will continue to practice it despite our best interventions. There can be a great deal of shame associated with it for our patients, and so clinicians need a skill set of contextual and cultural competency and communication skills to effectively convey the risks to our patients. A 3-day, multiple-partner ChemSex environment is pregnant with the possibilities of HIV/HCV infection, from many diverse sources; this guide [4] endeavors to equip healthcare providers with the language and contexts of such an environment to better inform our patients.Q Is HIV/HCV coinfection & substance abuse as much as a problem for women?There is little evidence that injecting drug use by women is increasing in the UK; in fact it appears to be lessening, according to Public Health England [5]. That is not to say that we must not remain vigilant in asking about drug use in genito-urinary medicine/HIV services, and continuing to provide screening and support in drug services.Q As a substance-abuse advisor, how do you see the adoption of this guide affecting the lives of patients who have HIV/HCV coinfection & have sex when taking drugs? How will the guide help encourage testing & treatment?Patients' shame and perceptions of judgement, as well as ignorance on behalf of clinicians are the greatest obstacles to HIV/HCV prevention among this population. This guide equips clinicians with colloquial terms and contextual detail that should facilitate more candid dialogue between ChemSex patients and clinicians. It should dispel any fears clinician's might have of appearing naïve of the behaviors, and it details the exact transmission risks in a ChemSex environment, hour by hour, play by play. A patient, who is convinced by a clinician's cultural awareness, will disclose more honestly his behaviors, and ask more boldly, questions relating to transmission. And a clinician can then more thoroughly equip his/her patient with accurate harm-reduction advice. This will significantly reduce infection rates and keep our patients confidently engaged in their healthcare.Q As someone who has devoted their career to raising awareness & helping those with substance abuse, & now in terms of HIV/HCV, what do you see as priorities for improving care & advice further in this area in the UK?The priorities for me, continue to be improving the discourse between patients and their healthcare providers, as well as addressing stigma, ignorance and confusing messages regarding transmission, screening and treatment. The ChemSex syndemic is associated with chaotic drug use and extreme sexual behaviors, high rates of injecting drug use by an injecting-naive population among whom HIV and hepatitis C are highly prevalent. It is, the perfect storm. Clinicians need a confident awareness of cultural context, language and risks, in order to effectively address this challenging public health concern.DisclaimerThe opinions expressed in this interview are those of the interviewees and do not necessarily reflect the views of Future Medicine, Ltd.Financial & competing interests disclosureThe author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.No writing assistance was utilized in the production of this manuscript.References1 ChemSex; a working definition for healthcare providers. www.chemsexsupport.com/chemsex-definition.Google Scholar2 Stuart D. Sexualised drug use by MSM: background, current status and response. www.davidstuart.org/nursing-journal-1.Google Scholar3 Dean street wellbeing programme www.deanstreetwellbeingprogramme.com.Google Scholar4 ChemSex and Hepatitis C. A Guide for Clinicians. www.chemsexsupport.com/chemsex-co-infection-booklet.Google Scholar5 Data from National Drug Treatment Monitoring Service (NDTMS), Public Health England. www.gov.uk/government/statistics/announcements/drug-treatment-statistics-in-england-december-2014.Google ScholarDavid Stuart is the Substance Use Lead at London's 56 Dean Street (GUM/HIV services), addressing the sexualized drug use behaviors of MSM, commonly referred to as ChemSex. David has developed tailored interventions and care pathways for ChemSex trends, and has been instrumental in putting ChemSex on the Public Health agenda as well as pioneering the National Health Service and community responses.FiguresReferencesRelatedDetailsCited BySubcutaneous Stories from the Deviant City: Chemsex Congregations, Urban Explorations, and Occult Inclinations in the Art of Manchester Penetrated8 April 2023The rise of chemsex: queering collective intimacy in neoliberal London22 February 2018 | Cultural Studies, Vol. 33, No. 2 Vol. 10, No. 4 STAY CONNECTED Metrics History Published online 27 April 2015 Published in print April 2015 Information© Future Medicine LtdDisclaimerThe opinions expressed in this interview are those of the interviewees and do not necessarily reflect the views of Future Medicine, Ltd.Financial & competing interests disclosureThe author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.No writing assistance was utilized in the production of this manuscript.PDF download